Suicidal Thoughts & Crisis Support
Suicidal thoughts range from passive wishes to not exist to active thoughts with a specific plan; both deserve serious attention and support, per the 2024 VA/DoD Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide. Passive thoughts are not "safe" simply because they lack a plan -- research shows they carry real risk and can progress to active thoughts, so any level of suicidal thinking warrants a conversation with a professional.
Symptoms
Warning signs include talking about wanting to die or being a burden to others, withdrawing from people and activities, giving away possessions, increased substance use, dramatic mood changes, hopelessness, and -- most urgently -- seeking access to a means of self-harm (such as researching methods or acquiring a weapon or medication).
Causes and risk
Suicide risk arises from an interaction of many factors: a mental health condition (especially depression, bipolar disorder, or substance use disorder), a prior suicide attempt, access to lethal means, social isolation, a recent major loss or crisis, and chronic pain or illness. Having risk factors does not mean someone will act on suicidal thoughts, and having none does not mean someone is not at risk.
How it is evaluated
A direct, specific conversation about thoughts, plan, and intent is the standard of care -- asking about suicide does not increase risk and is required by the Joint Commission’s National Patient Safety Goal for suicide prevention, which calls for validated screening starting at age 12, with risk level documented and a follow-up plan set before the visit ends.
Treatment
Collaborative safety planning -- a specific, written plan identifying warning signs, coping strategies, people to contact, and how to make the environment safer -- is one of the two interventions with the strongest evidence for reducing future attempts, alongside reducing access to lethal means (medication, firearms), per SAMHSA and the National Action Alliance for Suicide Prevention’s recommended standard care. Follow-up contact after a crisis (a phone call or message checking in) is also evidence-based and reduces risk. "No-suicide contracts" -- asking someone to simply promise not to harm themselves -- are not effective and are no longer recommended, since they can discourage honest disclosure.
When to seek care
If you or someone you know is in immediate danger, call 911 or go to the nearest emergency room. For crisis support any time, day or night, call or text 988 to reach the 988 Suicide and Crisis Lifeline (press 1 for the Veterans Crisis Line), or text HOME to 741741 to reach the Crisis Text Line. If you're with someone in crisis, stay with them, remove access to any means of self-harm you can safely remove, and help them connect to one of these resources -- you do not have to manage this alone.